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Nasal Carriage of Methicillin-Resistant Staphylococcus aureus in an American Indian Population

Published online by Cambridge University Press:  02 January 2015


Richard Leman
Affiliation:
Centers for Disease Control and Prevention, Division of Applied Public Health Training, Epidemiology Program Office, Epidemie Intelligence Service Branch, Atlanta, Georgia Indian Health Service, National Epidemiology Program, Albuquerque, New Mexico
Francisco Alvarado-Ramy
Affiliation:
Centers for Disease Control and Prevention, Division of Applied Public Health Training, Epidemiology Program Office, Epidemie Intelligence Service Branch, Atlanta, Georgia Centers for Disease Control and Prevention, National Center for Infectious Diseases, Division of Healthcare Quality Promotion, Atlanta, Georgia
Sean Pocock
Affiliation:
University of Arizona Schools of Medicine and Public Health, Tucson, Arizona
Neil Barg
Affiliation:
University of Michigan School of Medicine, Ann Arbor, Michigan
Molly Kellum
Affiliation:
Centers for Disease Control and Prevention, National Center for Infectious Diseases, Division of Healthcare Quality Promotion, Atlanta, Georgia
Sigrid McAllister
Affiliation:
Centers for Disease Control and Prevention, National Center for Infectious Diseases, Division of Healthcare Quality Promotion, Atlanta, Georgia
James Cheek
Affiliation:
Indian Health Service, National Epidemiology Program, Albuquerque, New Mexico
Matthew Kuehnert
Affiliation:
Centers for Disease Control and Prevention, National Center for Infectious Diseases, Division of Healthcare Quality Promotion, Atlanta, Georgia

Abstract

Background and Objective:

Although reports of methicillin-resistant Staphylococcus aureus (MRSA) infections without healthcare exposure are increasing, population-based data regarding nasal colonization are lacking. We assessed the prevalence of and risk factors for community-associated MRSA nasal carriage in patients of a rural outpatient clinic.

Design:

A cross-sectional population survey was conducted through random sample and stratification by community of residence. Recent healthcare exposure (ie, hospitalization, dialysis, or healthcare occupation) and other risk factors for MRSA carriage were assessed. Cultures of the nares were performed. Community-associated MRSA was defined as MRSA carriage without healthcare exposure.

Setting:

A predominantly American Indian community in Washington.

Patients:

Those receiving healthcare from an Indian Health Service clinic.

Results:

Of 1,311 individuals identified for study, 475 (36%) participated. Unsatisfactory culture specimens resulted in exclusion of 6 participants. In all, 128 (27.3%) of 469 participants had S. aureus. Nine (1.9%) of 469 had MRSA carriage; of these, 5 had community-associated MRSA (5 of 469; overall community-associated MRSA carriage rate, 1.1%). MRSA carriage was associated with antimicrobial use in the previous year (risk ratio [RR], 7.2; P = .04) and residence in a household of more than 7 individuals (RR, 4.5; P= .03). Pulsed-field gel electrophoresis indicated that 5 (55%) of 9 MRSA carriage isolates were closely related, including 3 (60%) of 5 that were community associated.

Conclusions:

Prevalence of community-associated MRSA colonization was approximately 1% in this rural, American Indian population. Community-associated MRSA colonization was associated with recent antimicrobial use and larger household.


Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2004

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